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Flu Pandemic Secondary Hazards / Events

The 20th century pandemics have shared similar characteristics: in each pandemic, about 30% of the U.S. population developed illness, with about half seeking medical care. The greatest secondary hazard will be the problems caused by shortages of medical supplies (e.g., vaccines and antiviral drugs), equipment (e.g., mechanical ventilators), hospital beds, and health care workers.

Having a detailed system for allocating resources potentially can reduce such difficulties. This system ideally should be in place well before an influenza pandemic actually occurs. Also of particular concern is the real likelihood that health care systems, particularly hospitals, will be overwhelmed. Another important secondary hazard is the disruption that might occur in society. Institutions, such as schools and workplaces, may close because a large proportion of students or employees are ill. A large array of essential services may be limited because workers are off work due to pandemic influenza. Travel between cities and countries may be sharply reduced.

The healthcare system will be severely taxed if not overwhelmed due to the large number of illnesses and complications from influenza requiring hospitalization and critical care. CDC models estimate increases in hospitalization and intensive care unit demand of more than 25% even in a moderate pandemic. In a pandemic, everything from syringes to hospital beds, respirators, masks and protective equipment would be in short supply. Ventilators will be the most critical shortage in a pandemic.

The response to an influenza pandemic will pose substantial physical, personal, social, and emotional challenges to healthcare providers, public health officials, and other emergency responders and essential service workers. During an influenza pandemic, however, the occupational stresses experienced by healthcare providers and other responders are likely to differ from those faced by relief workers in the aftermath of a natural disaster. Globally and nationally, a pandemic might last for more than a year, while disease outbreaks in local communities may last 5 to 10 weeks. Medical and public health responders and their families will be at personal risk for as long as the pandemic continues in their community. Special planning is therefore needed to ensure that hospitals, public health agencies, first-responder organizations, and employers of essential service workers are prepared to help employees maximize personal resilience and professional performance. An essential part of this planning effort involves the creation of alliances with community-based organizations and nongovernmental organizations with expertise in and resources for psychosocial support services or training.

The pandemic is expected to have substantial impact on the healthcare system with large increases in demand for healthcare services placed on top of existing demand. Healthcare workers (HCW) will be treating influenza-infected patients and will be at risk of repeated exposures. Further, surge capacity in this sector is low. To encourage continued work in a high-exposure setting and to help lessen the risk of healthcare workers transmitting influenza to other patients and HCW family members, this group was highly prioritized. In addition, increases in bed/nurse ratios have been associated with increases in overall patient mortality. Thus, substantial absenteeism may affect overall patient care and outcomes.

Healthcare workers and other emergency responders should be provided with information on what to do if they or their children or other family members experience stigmatization or discrimination because of receiving vaccines or antiviral drugs before other people. Stigmatization and discrimination (e.g., being shunned as a perceived source of contagion) can be especially difficult and potentially dangerous during an infectious disease outbreak.

During an influenza pandemic, state and local health agencies should consider implementing workforce resilience programs that meet the special needs of deployed workers-including workers who do not change job site but whose assignments shift to respond to the pandemic-and the central operations personnel who support them around the clock. First-responder or nongovernmental organizations that send employees or volunteers to assist patients at home or in hospitals might establish similar programs.

During a pandemic wave in a community, between 25% and 30% of persons will become ill during a 6 to 8 week outbreak. Among working-aged adults, illness attack rates will be lower than in the community as a whole. A CDC model suggests that at the peak of pandemic disease, about 10% of the workforce will be absent due to illness or caring for an ill family member. Impacts will likely vary between communities and work sites and may be greater if significant absenteeism occurs because persons stay home due to fear of becoming infected.

Only limited information is available from which to assess potential impacts on critical infrastructure sectors such as transportation and utility services. Because of changes in business practices and the complexity of networks, information from prior pandemics is not considered applicable.

Critical infrastructure sectors fulfill one or more of the following criteria: have increased demand placed on them during a pandemic, directly support reduction in deaths and hospitalization; function is critical to support the healthcare sector and other emergency services, and/or supply basic necessities and services critical to support of life and healthcare or emergency services.

Maintaining certain key functions is important to preserve life and decrease societal disruption. Heat, clean water, waste disposal, and corpse management all contribute to public health. Ensuring functional transportation systems also protects health by making it possible for people to access medical care and by transporting food and other essential goods to where they are needed.

Critical infrastructure groups that have impact on maintaining health include public safety or transportation of medical supplies and food; implementing a pandemic response; and maintaining societal functions. Public safety workers included police, fire, 911 dispatchers, and correctional facility staff (2.99 million). Utility workers are essential for maintenance of power, water, and sewage system functioning (364,000). Transportation workers transport fuel, water, food, and medical supplies as well as public ground public transportation (3.8 million). Telecommunications/IT is essential network operations and maintenance (1.08 million).

Persons directly involved with influenza vaccine and antiviral medication manufacturing and distribution and essential support services and suppliers (e.g., growers of pathogen-free eggs for growth of vaccine virus) production activities.

Key government leaders and health decision-makers will be needed to quickly move policy forward on pandemic prevention and control efforts. Public safety workers (firefighters, police, and correctional facility staff, including dispatchers) are critical to maintaining social functioning and order and will contribute to a pandemic response, for example by ensuring order at vaccination clinics and responding to medical emergencies.

Utility service workers (water, power, and sewage management) are prioritized as the services they provide are also essential to the healthcare system as well as to preventing additional illnesses from lack of these services unrelated to a pandemic. Transportation workers who maintain critical supplies of food, water, fuel, and medical equipment and who provide public transportation, which is essential for provision of medical care and transportation of healthcare workers to work and transportation of ill persons for care. Telecommunication and information technology services critical for maintenance and repairs of these systems are also essential as these systems are now critical for accessing and delivering medical care and in support of all other critical infrastructure.

Mortuary services will be substantially impacted due to the increased numbers of deaths from a pandemic and the fact that impact will be high in the elderly, a growing segment of the population. The timely, safe, and respectful disposition of the deceased is an essential component of an effective response. Pandemic influenza may quickly rise to the level of a catastrophic incident that results in mass fatalities, which will place extraordinary demands (including religious, cultural, and emotional burdens) on local jurisdictions and the families of the victims. A catastrophic incident involving mass fatalities will require federal assistance to transport, process, and store deceased victims and support final disposition and personal effects processing. Most local jurisdictions will be severely strained to handle mass fatalities or may experience profound difficulties.

DoD Health Affairs indicates that 1.5 million service members would require immunization to continue current combat operations and preserve critical components of the military medical system. Should the military be called upon to support civil authorities domestically, immunization of a greater proportion of the total force will become necessary. These factors should be considered in the designation of a proportion of the initial vaccine supply for the military.



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